Boriani Filippo, Fazio Nicola, Bolognesi Federico, Pedrini Francesca Alice, Marchetti Claudio, Baldini Nicola
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
Orthopaedic Pathophysiology and Regenerative Medicine Unit, Istituto Ortopedico Rizzoli, IRCCS, Bologna, Italy.
World Neurosurg. 2019 Feb;122:692-703.e2. doi: 10.1016/j.wneu.2018.10.195. Epub 2018 Nov 7.
Acellular nerve allografts (ANAs) have been established as promising alternatives to autologous nerve grafts, which represent the reference standard. Our research group recently performed a systematic review of reported cell-based-enriching methods for recellularization of ANAs. Recellularization results in consistent improvement of peripheral neuroregeneration compared with plain ANAs. We systematically reviewed the effects on nerve regeneration when ANA enrichment was obtained through biological, chemical, and physical modification instead of cells.
The PubMed, ScienceDirect, Medline, and Scopus databases were searched for reports of noncellular modification of ANAs, reported from January 2007 to December 2017. The inclusion criteria were English language, noncellular enrichment of ANAs in peripheral nerve regeneration, an in vivo study design, and postgrafting neuroregenerative outcomes assessment. The exclusion criteria were the central nervous system as the site of ANA application, nerve conduits, xenografts, case series, case reports, and reviews.
Only animal studies were found to be eligible. We included 16 studies, which were analyzed regarding the animal model, decellularization method, graft-enriching mode, and neuroregenerative tests performed.
Noncellular-based stimulation of ANAs demonstrated positive effects on recovery of nerve function compared with nerve grafting compared with plain ANAs. The neuroregenerative effect of autografting still appeared superior to ANAs, even with noncellular enrichment of ANAs. However, we found that in a few studies, modified ANAs closely approached or even outperformed autografts. Future research should include more preclinical investigations of this promising tool and clinical translation to increase the level of evidence available in the challenging field of peripheral nerve reconstruction.
脱细胞神经同种异体移植物（ANA）已被确立为自体神经移植物的有前景的替代物，自体神经移植物是参考标准。我们的研究小组最近对报道的用于ANA再细胞化的基于细胞的富集方法进行了系统评价。与单纯的ANA相比，再细胞化可使周围神经再生持续改善。我们系统评价了通过生物、化学和物理修饰而非细胞获得ANA富集时对神经再生的影响。
检索PubMed、ScienceDirect、Medline和Scopus数据库，查找2007年1月至2017年12月报道的ANA非细胞修饰的研究报告。纳入标准为英文、外周神经再生中ANA的非细胞富集、体内研究设计以及移植后神经再生结果评估。排除标准为ANA应用部位为中枢神经系统、神经导管、异种移植物、病例系列、病例报告和综述。
仅发现动物研究符合条件。我们纳入了16项研究，对其动物模型、脱细胞方法、移植物富集模式和进行的神经再生试验进行了分析。
与单纯的ANA相比，基于非细胞的ANA刺激对神经功能恢复显示出积极作用，与神经移植相比也是如此。即使ANA进行了非细胞富集，自体移植的神经再生效果似乎仍优于ANA。然而，我们发现，在一些研究中，修饰后的ANA与自体移植物相近甚至表现更优。未来的研究应包括对这一有前景的工具进行更多的临床前研究以及临床转化，以提高在具有挑战性的周围神经重建领域的现有证据水平。
